Provider Demographics
NPI:1124134986
Name:RASKOLNIKOV, LENNA (LMSW ACSW)
Entity type:Individual
Prefix:MS
First Name:LENNA
Middle Name:
Last Name:RASKOLNIKOV
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23113
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-3113
Mailing Address - Country:US
Mailing Address - Phone:517-853-2992
Mailing Address - Fax:517-853-2993
Practice Address - Street 1:4990 NORTHWIND DR
Practice Address - Street 2:SUITE 240
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5090
Practice Address - Country:US
Practice Address - Phone:517-853-2992
Practice Address - Fax:517-853-2993
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010712121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P40790Medicare ID - Type UnspecifiedGROUP NUMBER